NURSING DEPARTMENT, MEDICINE AND HEALTH COLLEGE
Lishui University, China
FACULTY OF HEALTH AND OCCUPATIONAL STUDIES
Department of Caring Sciences
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Nurse's experience of caring infants in neonatal
intensive care unit
A descriptive review
A descriptive review
Gu Yufei (Gwen)
Xiong Shuyan (Anastasia)
2020
Student thesis, Bachelor’s degree, 15 credits Nursing
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Abstract
Background: The death rate of newborns is very high. At the same time, because of the
special physiological characteristics of newborns, it brings a lot of pressure to the nurses in NICU. It is of great significance to pay attention to the work experience of nurses in neonatal intensive care unit (NICU) for relieving the psychological burden of nurses and improving the quality of nursing.
Aim: To describe nurses’ experience of caring infants in neonatal intensive care unit. Design: A descriptive review of qualitative studies.
Method: Articles were searched from PubMed and CINAHL. The appropriate articles
were selected and read for several times, the results were extracted, the similarities and differences were compared, then the results were synthesized.
Results: There were 10 articles included in the review. The results were divided into four
themes: (1). Nurses’ emotional experience during the nursing process; (2). Nurses’ difficulties during the nursing process; (3). What to do; (4). Adaption and coping during the nursing process. Nurses’ emotional experiences in their work can be negative and positive. The difficulties they encountered in nursing work came from their parents, from the nursing environment, and lacked of nursing skills. Based on these difficulties, they took corresponding measures.
Conclusions: Nurses in NICU had both negative and positive emotions. While taking care of the newborns, nurses also provide psychological support to the infants’ parents which increased the difficulty and pressure of the work. Better cooperation in nursing team was also required. Therefore, the nurses in NICU must have seasoned knowledge, working experience to alleviate the huge work tasks, and good coping strategies must be drawn up.
3 Content
1 Introduction ... 5
1.1 Background ... 5
1.2 Definition ... 5
1.2.1 Neonatal intensive care unit (NICU) - definition ... 5
1.2.2 Nursing - definition ... 5
1.3 Vulnerability of the infants ... 6
1.4 The experience of the parents ... 6
1.5 Nursing role ... 6
1.6 Nursing theory ... 7
1.7 Early review ... 7
1.8 Problem Statement ... 8
1.9 Aim and research questions ... 8
2 Method ... 8
2.1 Design ... 8
2.2 Search strategy ... 8
2.3 Selection criteria ... 10
2.4 Selection process and results of potential articles ... 10
2.5 Data analysis ... 11
2.6 Ethical considerations ... 12
3 Results ... 12
3.1 Nurses’ emotional experience during the nursing process ... 13
3.1.1 Positive emotions ... 13
3.1.2 Negative emotions ... 13
3.2 Nurses’ difficulties during the nursing process ... 14
3.2.1 Difficulties in caring for parents ... 14
3.2.2 Difficulties for nurse and care requirement ... 14
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3.2.4 Adverse effects of nursing environment ... 15
3.3 What to do ... 16
3.3.1 Giving support to parents ... 16
3.4 Adaption and coping during the nursing process ... 17
3.5 The chosen articles information ... 17
4 Discussion ... 18
4.1 Main results ... 18
4.2 Results discussion ... 19
4.2.1 The importance of regulating emotions ... 19
4.2.2 The need for effective communication ... 20
4.2.3 The importance of nursing skills ... 20
4.2.4 The uncertainly of children’s prognosis ... 21
4.2.5 The influence of NICU environment ... 22
4.2.6 Giving support to parents ... 23
4.2.7 Adaption and coping ... 24
4.3 Method discussion ... 25
4.4 Clinical implication for nursing ... 25
4.5 Suggestions for further research ... 26
5 Conclusions ... 26
References ... 27
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1 Introduction
1.1 Background
There were 15.23 million newborns born in China in 2018, but not all newborns can survive (National Health and Family Planning Commission of China, 2018). The mortality rate of newborn infants is extremely high. Neonates have immature functions and weak resistance (Zhang, 2017). They are more likely to suffer from serious diseases in the course of infection than adults, and susceptible to infection, so they belong to special protection groups (Yang, 2017). Newborn infants are more delicate than adults, so special nursing care and strict management mode should be adopted in the process of nursing care (Han & Wang, 2016). In view of the particularity of neonatal care, neonatal intensive care unit (NICU) have been specially established as a special intensive care unit for neonates (Yang, 2017).
1.2 Definition
1.2.1 Neonatal intensive care unit (NICU) - definition
NICU is a special ward that provided care for sick or premature infants from birth to 28 days after birth (National Association of Neonatal Nurses, 2013). Nurses working in this department need to master a series of professional skills about perinatal, prenatal and neonatal development, be able to deal with premature babies, various diseases, congenital malformations, surgery, and effectively assist in providing their family both physical and emotional support (American Nurses Association, 2003). At the same time, the environment of NICU is greatly affected by the high stress of family members, nurses' practice is based on family-centered nursing concept (American Nurses Association, 2003).
1.2.2 Nursing - definition
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1.3 Vulnerability of the infants
According to the special physiological characteristics of newborns, the newborns’ resistance to disease are very weak, which leads to greater fluctuations in their condition, so NICU needs a relatively aseptic environment (Yang, 2017). At the same time, newborns can't express their experience or pain in words, and crying is all they can do (Yang, 2017). These infants in NICU are at high risk of developmental retardation and disability (Gonya et al., 2018). Extreme early childbirth (defined as gestational age less than 27 weeks) are often accompanied by a wide range of medical complications, such as cerebral hemorrhage, infection, bronchopulmonary dysplasia and feeding intolerance (Gonya et al., 2018). Premature infants in NICU usually have a variety of risk factors, including jaundice, feeding problems and crying behaviors (Pearson & Boyce, 2004). Feeding problems are manifested in the fact that infants may suffer from dysphagia and refuse to feed, leading to differences in body weight, length and head circumference between the healthy full-term infants (Hill et al., 2009). As a result, newborns hospitalization time were generally more than six times longer than that of adults (Gonya et al., 2018).
1.4 The experience of the parents
Most mothers have some knowledge of feeding full-term babies, but they have insufficient knowledge of taking care of the infants in NICU (Hill, 2015). They thought that the infants in NICU are very vulnerable and are very worried about their health and nutritional status (Hill, 2015). Facing the birth of a fragile newborn means that the family will face challenges and exhaustion (Merighi et al., 2011). they can't visit their babies, but want to know about their baby, which makes parents full of anxiety (Merighi et al., 2011). Therefore, nurses in NICU not only need to take care for neonates, but also need to give the social, emotional and psychological support for the family (Vasconcelos et al, 2006).
1.5 Nursing role
Nurses play multiple roles in clinical work. They are caregivers, communicators and managers.
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Prendergast, 2007), provide support to reduce the parents’ anxiety and fear, to strive to cope with parents' concerns (Gaíva & Scochi, 2005).
As communicators, nurses need to be able to communicate effectively and accurately with patients and their families in order to meet the medical and health needs of patients (Kozier, 2012).
As managers, nurses manage personal and family care, support the activities of other staff members, and monitor and evaluate their performance (Kozier, 2012). they can effectively guide the team to carry out continuous improvement of nursing work (Gaíva & Scochi, 2005).
1.6 Nursing theory
The theory of adaptability was put forward by Roy. Roy's theory including person, environment, health and nursing (Roy, 2009). Person need constantly adapt to various stimuli of the internal and external environment (Roy, 2009). The environment includes both internal and external parts of the body (Roy, 2009). Health is a successful adaptation to the environment. Failure to adapt to the environment can lead to disease (Roy, 2009). Nursing is to help people to adapt the environment (Roy, 2009).
Nurses in NICU as persons, are open system, constantly disturbed by the environment. In NICU, the sudden deterioration of the patient's condition and the negative emotions of family members may make them sad and painful. Sometimes they cannot adapt to this high-pressure environment, causing psychological harm and prompting nurses unhealthy.
1.7 Early review
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premature infants. The study concluded that mothers believed that hospitalization time in NICU was negatively correlated with children's vulnerability, while babies were considered more vulnerable if they had more feeding problems.
1.8 Problem Statement
Exploring the nurses’ experience in NICU can improve the management and training effect of nurses in the NICU, improve the nurses’ professionalism and adaptability, and reduce staff turnover. Early reviews on nurses' experience working in NICU were limited in a single aspect, such as nurses' experience about providing care for the newborn in front of their parents,while our review was not limited to a single angle, the experience of nurses in NICU would be mentioned more comprehensively. Through summarizing and analyzing of the working experience of nurses in neonatal intensive care unit, authors can understand nurses' emotional feelings and sources of stress, thus formulate a series of measures to reduce stress, improve the work enthusiasm of nurses in neonatal intensive care unit and improve the quality of nursing care.
1.9 Aim and research questions
The aim of the literature review was to describe nurses’ experience of caring infants in neonatal intensive care unit with the following question:
-What experience did nurses gain from caring for infants in neonatal intensive care unit?
2 Method
2.1 Design
The descriptive review was used (Polit & Beck, 2017).
2.2 Search strategy
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limited to ten years and must be an English article. In the initial screening, seen Table 1, left 32 possible articles that can be used and matched the aim.
Table 1. Results of database searches.
Database Limits and search date
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2.3 Selection criteria
Inclusion criteria: Consistent with the aim of the study; nurses needed have experience of working in NICU or worked in NICU in the past; all articles used qualitative methods. Exclusion criteria: Participants were only parents or doctors; the article did not mention the experience of nurses in NICU; the article was a review or a quantitative study.
2.4 Selection process and results of potential articles
11 Figure 1. Selection process
2.5 Data analysis
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2.6 Ethical considerations
When reading the relevant literature, we kept objective and impartial, and were not influenced by the position of other articles. The results were completely objective. At the same time, plagiarism was avoided.
3 Results
The results were draw based on 10 articles, which were qualitative studies. The articles presented nurse's experience of caring infants in neonatal intensive care unit. The themes and sub-themes of the results were presented in table 1. Four themes were summarized as nurses’ experiences of caring infants in neonatal intensive care unit: (1) Nurses’ emotional experience during the nursing process; (2) Nurses’ difficulties during the nursing process; (3) What to do; (4) Adaption and coping during the nursing process.
Table 1
Themes Sub-themes
Nurses’ emotional experience during the nursing process
Positive emotions Negative emotions
Nurses’ difficulties during the nursing process
Difficulties in caring for parents Difficulties for nurse and care requirement
Difficulties in caring for infant Adverse effects of nursing environment
What to do Giving support to parents
Adaption and coping during the
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3.1 Nurses’ emotional experience during the nursing process
3.1.1 Positive emotions
Two articles mentioned the positive emotions of nurses in caring for newborns (Gallagher et al., 2017 & Turner et al., 2014). Most of nurses described that recover of the child under their caring was a positive experience (Turner et al., 2014). Because, for nurse, it was a pleasure to be able to take care of them, and they would feel happy when they made babies back to health by their expertise (Gallagher et al., 2017). Some nurses said it was the duty to make patients happy, to help them in their fight back to health and strength, which made them feel proud (Green et al., 2014). In addition, the work was an enjoyable thing for some nurses (Gallagher et al., 2017). Some nurses said the patients were helpful to establish them, so that they can fully exerted their potential to achieve success (Green et al., 2015). Despite these challenges, nurses hold different perceptions of reality, they can cope their work by finding their work meaningful (Strandas & Fredriksen, 2014). While challenged by the children’s conditions, their helplessness, and struggle for survival, nurses found strength in helping them, in making them different and in seeing infants recover and discharged (Green et al., 2015 & Green et al., 2014).
3.1.2 Negative emotions
At the same time, caring for children may have some negative emotions, which was described in five articles (Green et al., 2015 & Feeley et al., 2018 & Ford & Austin 2017 & Fernanda et al., 2018 & Green et al., 2014). The nurses reported that they felt a high level of mental tension because the work load in the NICU was heavy, requiring both treatment and nursing care (Green et al., 2014). Many nurses worked in a stressful environment where the newborns in were premature who lack of some human-recognizable physical characteristics and were not stable (Green et al., 2015 & Feeley et al., 2018). In addition, most of the nurses worried about medical errors because newborns had no verbal competence and were looked very similar (Green et al., 2015).
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3.2 Nurses’ difficulties during the nursing process
3.2.1 Difficulties in caring for parents
Nurses believed that their role in the neonatal intensive care unit was challenging, and part of the challenge came from parents, which were shown in three articles (Turner et al., 2014 & Strada & Sven-Tore., 2015 & Trajkovski et al., 2014).
The nurses reported that the parents would feel anxious because they lacked the necessary skills to care for the newborn, and the anxiety and tension would be conveyed to the nursing staff through the family members, hindered the smooth implementation of the nursing work (Turner et al., 2014).
Moreover, most family members failed to understand the work of caregivers because they lacked knowledge of the disease which was caused by ineffective communication (Trajkovski et al., 2014).Therefore many nurses described that they found it difficult to communicate with the patient’s family and was scarcely able to interact with their parents (Stranda & Sven-Tore, 2015 & Turner et al., 2014).
3.2.2 Difficulties for nurse and care requirement
The difficulties nurses encountered in caring for children were reflected in these six papers (Green et al., 2015 & Turner et al., 2014 & Feeley et al., 2016 & Ford & Austin, 2017 & Stranda & Sven-Tore, 2015 & Fernanda et al., 2018).
When nurses provided care for children and their families, they also needed to provide personalized care to each family based on each family’s different situation (Turner et al., 2014 & Stranda & Sven-Tore, 2015). Nurses thought it was difficult to continue to provide high-quality nursing care under high-intensity and high standard work in NICU, where was easy to cause high psychological tension and fatigue (Green et al., 2015 & Turner et al., 2014). They described that providing patients with high quality nursing and also to take into account the psychological nursing of their parents was challenging (Green et al., 2015 & Turner et al., 2014).
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Many nurses felt that they lacked the necessary skills to provide emotional support to their families, and that they were emotionally unprepared (Green et al., 2015 & Turner et al., 2014). This directly led to the nurses neglecting to provide emotional support to the children's families in their daily nursing work (Fernanda et al., 2018 & Green et al., 2014).
3.2.3 Difficulties in caring for infant
The particularity and importance of newborns added difficulty to nursing work was mentioned in three articles (Green et al., 2015 & Green et al., 2014 & Ford & Austin, 2017). Nurses reported the vulnerability and particularity of newborns, the physiological function of the children were poor, it was easy to be infected with diseases which brought a lot of trouble to the nursing work (Green et al., 2015 & Green et al., 2014). And the difference in appearance and particularity made newborns were considered by the nurses to be very fragile, so it was difficult to provide body care (Green et al., 2014 & Green et al., 2015). As the infant was a special group of children, there were some problems in the process of communication due to the children’s language incompetence (Green et al., 2015).
At the same time, due to the uncertain prognosis of infants, it was difficult for nurses to provide care for them. (Green et al., 2015 & Ford & Austin, 2017). Many nurses described some infants having a sense of strangeness and fear to the medical workers, and they were easy to cry. This situation made it difficult for them to concentrate while taking care of infants (Green et al., 2015).
3.2.4 Adverse effects of nursing environment
Adverse effect of environment in NICU on the growth and development of premature infants was stated in four articles (Turner et al., 2014 & Hall et al., 2010 & Feeley et al., 2016 & Ford & Austin, 2017).
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The narrow space of the neonatal intensive care unit, and the scarcity of employees was also mentioned in these two articles (Green et al., 2014 & Turner et al., 2014). The narrowness of the environment can bring a strong sense of discomfort to the newborn, delaying the premature infant’s future growth and development (Hall et al., 2010). The scarce of employees made the interruption of continuity of care and the quality of nursing declined. (Green et al., 201 4 & Turner et al., 2014 & Hall et al., 2010).
3.3 What to do
3.3.1 Giving support to parents
As the main support of infants’ treatment, parents needed the attention and support from nurses. This view reflected in these 6 articles (Feeley et al., 2016 & Turner et al., 2014 & Trajkovskr et al., 2012 & Gallagher et al., 2017 & Strand a& Sven-Tore., 2015 & Green et al., 2014).
As parents’ psychological pressure was too big, the nurse found it necessary to provide emotional support to their parents (Feeley et al., 2016 & Gallagher et al., 2017 & Trajkovskr et al., 2012).
Lacking effective communication unable the family members to cooperate with the treatment and interfere with nursing support (Stranda & Sven-Tore., 2015 & Turner et al., 2014). Many nurses thought that it was paramount to build trust with their parents (Trajkovskr et al., 2012), and communication must be based on trust and honesty (Stranda & Sven-Tore., 2015 & Trajkovskr et al., 2012). Most nurses would have more communication, participate in the discussion and activities of parents, to strengthen mutual understanding and trust (Stranda & Sven-Tore., 2015 & Turner et al., 2014).
Through the effective communication, the nurses stated that they can give disease-related knowledge to parents (Turner et al., 2014 & Green et al., 2014).
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3.4 Adaption and coping during the nursing process
Nurses had strategies for dealing with these difficulties.Three studies reported that adjustment was very important for achieving the best working efficacy (Hall et al., 2010&Ford & Austin, 2017 & Green et al., 2014). Many nurses found that they need to identify the pressure through their own steady state of mind,and handled the pressure correctly to achieve the best working state (Green et al., 2014). So emotional status was an important index in measuring the quality of nursing care. Some nurses with long-term working experience insisted that they needed to develop their own skills and framework to deal with the negative emotions that came from these very early babies (Ford & Austin, 2017 & Green et al., 2014).
Strengthen the training of nurses’ professional ability and nurses in emotional support skills were mentioned in three aticles (Ford & Austin, 2017& Gallagher et al., 2017 & Trajkovskr et al., 2012). Some nurses reduced the pressure on new technology through constant learning and training, understand cutting-edge nursing knowledge, so that their nursing skills can continue to develop (Gallagher et al., 2017). Nurses who had learned emotional support were better able to talk to their parents (Ford & Austin, 2017 & Gallagher et al., 2017 & Trajkovskr et al., 2012).
In addition, nurses advanced some advice to progress the humanized management (Hall et al., 2010). They mentioned the particularity of premature infants and need special sensitivity and concentration (Feley et al., 2016 & Green et al., 2014 & Hall et al., 2010 & Stranda & Sven-Tore, 2015). So that nursing workers should keep quiet and operate, reduced the stimulation to premature infants (Hall et al., 2010).
3.5 The chosen articles information
These ten articles were from seven countries: Australia (Trajkovski et al., 2010; Green et al., 2015; Green et al., 2014), Brazil (Fernanda et al., 2018), Canada (Feeley et al., 2016), Denmark (Hall et al., 2010), Norway (Stranda & Sven-Tore et al., 2015), Sydney (Turner et al., 2014), Vietnam (Ford & Austin et al., 2017; Gallagher et al., 2017).
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Stranda & Sven-Tore et al., 2015; Turner et al., 2014; Ford & Austin et al., 2017). In one of the articles, the participants were nurses and parents (Gallagher et al.,2017).
All of articles, used descriptive design (Trajkovski et al., 2010; Green et al., 2015; Green et al., 2014; Fernanda et al., 2018; Feeley et al., 2016; Hall et al., 2010; Stranda & Sven-Tore et al., 2015; Turner et al., 2014; Ford & Austin et al., 2017; Gallagher et al., 2017). In nine of the articles, the semi-structured interviews guide with questions were used (Trajkovski et al., 2010; Green et al., 2015; Green et al., 2014; Fernanda et al., 2018; Feeley et al., 2016; Stranda & Sven-Tore et al., 2015; Turner et al., 2014; Ford & Austin, et al., 2017; Gallagher et al., 2017). And the one remaining article didn’t mention which type of interview they used (Hall et al., 2010).
In all of the chosen articles, the interviews were recorded and transcribed verbatim (Trajkovski et al., 2010; Green et al., 2015; Green et al., 2014; Fernanda et al., 2018; Feeley et al., 2016; Hall et al., 2010; Stranda & Sven-Tore et al., 2015; Turner et al., 2014; Ford & Austin et al., 2017; Gallagher et al., 2017).
In two of the chosen articles, the articles didn’t mention the age or gender of the interviewees (Green et al., 2014; Gallagher et al., 2017). The remaining eight papers included the age, gender, number and work years of the interviewees (Trajkovski et al., 2010; Green et al., 2015; Fernanda et al., 2018; Feeley et al., 2016; Hall et al., 2010; Stranda & Sven-Tore et al., 2015; Turner et al., 2014; Ford & Austin et al., 2017).
4 Discussion
4.1 Main results
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4.2 Results discussion
4.2.1 The importance of regulating emotions
Nursing a baby could have some psychological effects on nurses. They felt unexpected, powerless, fear, worried, sad and other negative feelings (Green et al., 2015 & Feeley et al., 2018 & Ford & Austin, 2017 & Fernanda et al., 2018 & Green et al., 2014). This was in line with the result in Vaismoradi (2011), as it mentioned that the negative emotions stemmed from the uncertainly of prognosis could prompt feelings of frustration, anger, agitation and fear in nurses. This review reported that neonatal nurses felt hard to manage their own mood (Green et al., 2016). Similar result can be found in Hale & Levy (1982) study. They acknowledged that dealing with the negative emotions associated with caring for a baby and their parents could be stressful for them.
Most nurses stressed that they had to develop their own emotional coping framework and special way to help them endure the negative emotions brought by work (Green et al., 2016). Similar result can be found in Jansen et al., (2011), they advocated nurses to face their emotions and replace negative thoughts with humor such as "joking".
The goal of emotional stability could be achieved through optimism therapy which elucidated by Jansen (2011), while remaining optimistic, the nurses showed an understanding of the patient’s prognosis. Nurses should maintain an optimistic attitude in their nursing work, because sometimes they may often face situations that made them pessimistic rather than optimistic (Jasen et al., 2011).
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4.2.2 The need for effective communication
Working in NICU was a challenging with the demands of taking care of the infant and providing family-centred care, this included need of communication with parents (Stranda & Sven-Tore., 2015 & Trajkovskr et al., 2012 & Turner et al., 2014 & Green et al.,2014). Similar result can be founded in Cone et al., (2007) study, parents want to know as much as they can about their babies. But communicating with a nurse in a busy NICU was neither easy nor intuitive (Hall et al., 2010). This was in line with the result in Lupton (2001). Direct and clear communication with nurses enabled parents to know their child.
The nurses said they must made parents feel included and recognized when nurses’ and parents’collide in some way (Strandas & Fredriksen, 2015). In situations where parents did not understand or agree with a certain measure of care, the nurses also found it difficult to carry out nursing work normally (Hall et al., 2010). Similar result can be found in Fegran et al., (2006). Effectively communicated with parents by listening to parents was an important duty of nurses.
In order to better communicate with parents, nurses should include informal chats as well as more formal discussions and emphasis the impact of emotions on parental communication (Jones et al., 2007). Communication needed to be directly and clearly with parents to avoid confusion (Cegala et al., 1995). At the same time, a nurse's politeness and respect and together with treating them as equals can also increase parent satisfaction (Fenwick et al., 2001).
In Roy's adaptation theory, the stimulation received by parents was the newborn was in NICU, and they were fear and anxious (Roy, 2009). Therefore, nurses must provide emotional support, effective communication can make parents trust nursing staff more and relieve tension.
4.2.3 The importance of nursing skills
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increasing their knowledge, impacting on practice and improving infant care (Gallagher et al., 2017). Similar result can be founded in Benner et al. (1982), to become an expert intensive care unit nurse, nurses need to spend more time to update knowledge.
Nurses viewed their role in requiring seniority, training and experience (Ford & Austin, 2017& Gallagher et al., 2017 & Trajkovskr et al., 2012). Nursing skills’ education and training were also considered to be factors that affected the ability of nurses to provide support (Turner et al.,2014). Similar result can be found in Green et al., (2006), they reported that knowledge and skills training can enhance the capabilities of medical personnel.
In order to change the practice effect, teaching and learning were needed to be maintained over a sustained period of time to ensure clinical quality (Thukral et al., 2015). Evaluation of the nurse ’s personal knowledge reserve was essential to ensure that an appropriate teaching plan was developed for the individual (Shrestha et al., 2013).
In Roy's adaptation theory, the nurses in NICU needed to adapt to the external environment (Roy, 2009). The work in NICU required nurses to have solid theoretical knowledge and superb clinical operation technology.In order to adapt to the working environment in NICU, the nurses must constantly improve their theoretical knowledge and operating skills to adapt to their high-pressure working environment.
4.2.4 The uncertainly of children’s prognosis
The uncertainty was related to caring for premature babies. Nurses reported that the vulnerability and particularity of the newborns, the poor physiological function which made them easy to be infected with diseases, brought a lot of uncertainly to the nursing work (Green et al., 2015 & Green et al., 2014), it was consistent with the study of McHaffie & Fowlie (1996), which found that tolerance of the grayness of uncertainty was hard for some neonatal staff members. Uncertainty about prognosis and results may confuse nurses' treatment and bring frustration to nurses (Green et al.,2015). This was in line with the result in Hale and Levy (1982), as it mentioned that care for children with uncertainty may put pressure on nurses.
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to manage the uncertainty about their baby (Green et al.,2015). Similar result can be found inVaismoradi (2011), they reported that uncertainty was ubiquitous in clinical nursing practice.
Hoping promoting strategies was considered to be a dynamic inner-power, enabled transcendence of the current situation and fosters positive new ways of awareness and being (Turner& Stokes 2006). Nurses recognized that parental hope was made possible through the development of a trusting relationship between the nurses and parents (Turner & Stokes 2006).
In Roy's adaptation theory, parents needed to adapt to all kinds of stimuli (Roy, 2009). The poor prognosis of infants may lead the change of parents' psychology, and excessive sadness would affect parents' health. Therefore, the nurse must inform the parents of the uncertainty of prognosis during the treatment, so gave the parents a period of time to adapt to prevent sudden changes in the condition.
4.2.5 The influence of NICU environment
There were many aspects of this critical care environment that pose challenges to closeness, this included noise, ward design, lack of privacy and other aspects (Turner et al., 2014 & Hall et al., 2010 & Feeley et al., 2016 & Ford & Austin, 2017). This was in line with the result in Heinemann (2013) & Wigert (2008), noise and lack of privacy were environmental factors that affect parents’ and infants' experience in NICU. What's more, nurse believed that even the smallest babies have personalities and that normalizing the environment in NICU was important to them (Green et al., 2015). Similar results can be founded in study by Browne et al. (2006). The physical structure of the NICU can greatly impact on the function of the NICU and the emotions of the staff and parents who used it.
Nurses had a vital role to play in controlling noise and provided privacy to support closeness (Feeley et al., 2016). Nurses pointed to care practices that could control aspects of the environment and in turn the closeness of parents and their babies in the NICU (Turner et al., 2014). Similar results can be founded in wigert et al. (2008), nursing intervention that supports closeness was imperative.
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al., 2013 & Flacking et al., 2014 & Browne et al., 2006). Meanwhile, the needed for privacy of infants and families should be addressed not only in the overall unit design, but also in the design of each bed space, for example, by minimizing traffic flow past each bed (White et al., 2013 & Flacking et al., 2014).
In Roy's adaptation theory, patients and newborns needed to receive stimulation from environment in NICU (Roy, 2009). That was to say, nurses need to improve the environment of NICU and provide parents' care for the newborn to provide a familiar and reassuring environment for patients and newborns, which was conducive to the recovery of newborns and the comfort of parents.
4.2.6 Giving support to parents
Nursing staffs described many problematic staffing issues, this included the range of skills of caregivers (Turner et al., 2014). This was in line with the result in Wigert (2006). The training and experience of the staff and the nurse's personal ability to establish emotional relationships with parents were factors that affect the nurse's ability to provide emotional care to babies and their families. Hence, more and more nurses realized that providing emotional care for parents was important that requires a lot of experience (Turner et al., 2014). Similar result can be found in Pannacciulli (2012), they reported that providing this emotional support to parents was a challenge for many nurses.
However, the reason why nurses thought provide emotional support as a challenge was lack of supportive education and training (Turner et al., 2014). Parents' desired for more support from nurses also reflected the importance of providing support (Gallagher et al., 2017). This finding was similar with the study by Pannacciulli (2012), they thought providing emotional support was viewed as enhancing closeness.
For nurses who may not be able to provide emotional support directly, we can provide a booklet about their babies that recorded information, so parents can recall the information, and it also useful for some nurses who were inexperienced and need to convey complex information (Koh et al., 2007).
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reduce the adverse stimulation of the external environment, and reduce the pressure of parents.
4.2.7 Adaption and coping
For nurses, difficulties were persisted. In long-term clinical work, nurses had different coping strategies based on different difficulties.
For the problem of negative emotions in NICU, some nurses with long-term experienced insisted that nurses needed to develop their own skills and frameworks to deal with (Ford & Austin, 2017 & Green et al., 2014). This finding was similar with the study by Jasen et al (2011). They showed that in order to have optimally work, neonatal nurses needed to develop their own techniques and methods to endure the environment in NICU. Nurses used humor to help them to provide care for some very precocious babies (Green et al., 2014).
Lack of personal expertise, some nurses reduced the pressure through studying new technology and constantly receiving training, so that their nursing skills can continue to grow and develop (Gallagher et al., 2017 & Ford & Austin, 2017 & Trajkovskr et al., 2012). Consistent with the study of Martinez et al (2012), this study founded that nurses with training can better provide neonatal care. Nurses had increased their pride in training by increasing their knowledge, impacting on practice and improving infant care (Gallagher et al., 2017).
In addition, nursing staffs made recommendations for humanized care. Based on the particularity of infants, nurses needed special sensitivity and attention to keep quiet in the nursing work and reduced the stimulation to the newborns (Feley et al., 2016 & Green et al., 2014 & Hall et al., 2010 & Stranda & Sven-Tore, 2015). It was in line with the results in the study of Fegran (2006). Nurses committed to ensure infants adequate rest and minimized sensory impressions such as pain, noise and light. Therefore, nursing workers should keep quiet and operative, reduced the stimulation to premature infants (Hall et al., 2010)
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was necessary for the nurses to adjust their mentality and improve their nursing level, so as to maintain their mental health and enough nursing ability to work.
4.3 Method discussion
First of all, the review had some advantages. First, the articles cited were published within 10 years, which was more closely to the current work status of nurses (Polit & Beck, 2017). Secondly, the inclusion criteria were strict, and the articles were all related to the aim (Polit & Beck, 2017). Third, the selected articles from different perspectives of nurses' work, covering nurses' emotional experience, working experience, what nurses to do, and how to deal, so as to enrich the results (Polit & Beck, 2017).
Then, the review also had its disadvantages. First, the cited articles that were searched through PubMed and CINAHL databases, may not fully represent the nurses’ experience in NICU (Polit & Beck, 2017). Second, the search restricts were must the English articles, may ignore some articles in different languages that fit the aim (Polit & Beck, 2017). Third, this article was mainly from the perspective of nurses and did not focus on the experiences of parents and doctors in the NICU, so it may not be comprehensive (Polit & Beck, 2017).
4.4 Clinical implication for nursing
26
4.5 Suggestions for further research
Most of the interviewees were women. However, there were some male nurses in NICU. Future research can have more male nurses, which may enrich the results. At the same time, the interviewees were only nurses, in the future research, doctors’ and patients' family’s views in NICU should be further explored, so that the results may be more objective and have substantial content. Finally, the interviews of existing article were only once, and the number of interviews can be increased in the future, and different result may be drawn by interviewing them in different periods of working years.
5 Conclusions
27
References
American Nurses Association. (2003). Nursing’s social policy statement. Washington, DC:
American Nurses Publishing. 89.
Benner P. (1982). From novice to expert. The American Journal of Nursing, 82.
Browne J., Cicco R., Erickson D., Graven S. N., Gregory S., Harrell J. W., Jaeger C. B., Johnson B.H., Kenner C., Kohlberg K. J. S., Little G. A., Marshall-Baker A., Mchglone C. A., Martin G. L., Philbin M..K., Rea M. S., Shepley M. M., Smith J. A., Vernon W. & White R. D. (2006). Report of the Sixth Census Conference on New born ICU Design,
Orlando, FL, pp. 15–17.
Cegala, D. J., Mcneilis, K. S. & Mcgee, D.S. (1995). A study of doctors’ and patients’ perceptions of information processing and communication competence during the medical interview. Health Communication, 7(3), 179-203.
Cone S. (2007). The impact of communication and the neonatal intensive care unit environment on parent involvement. Newborn Infant Nurs Rev, 7:33–8.
Fegran L., Helseth S. & Sletteb B. (2006). Nurses as moral practitioners encountering parents in neonatal intensive care units. Nurs Ethics; 13(1): 52–64.
Feeley N., Genest C., Niela-Vilén H., Charbonneau L. & Axelin A. (2016). Parents and nurses balancing parent-infant closeness and separation: a qualitative study of nicu nurses' perceptions. Bmc Pediatrics, 16, 134.
Feeley N., Waitzer E., Sherrard K., Boisvert L. & Zelkowitz P. (2012). Fathers’ perceptions of the barriers and facilitators to their involvement with their newborn hospitalized in the NICU. J Clin Nurs. 22(3–4): 521–30.
Fenwick J., Barclay L. & Schmeid V. (2001). Struggling to mother: a consequence of inhibitive nursing interactions in the neonatal nursery. Perinat Neonat Nurs; 15:49–64. Fernanda D.C. D. O., Cleveland L.M. Darilek U., Borges Silva A.R. & Carmona E.V. (2018). Brazilian neonatal nurses’ palliative care experiences. The Journal of Perinatal &
28
Flacking R. & Dykes F. (2014). Creating a positive place and space in NICUs. Pract
Midwife. 17(7): 18–20.
Ford, N.J. & Austin W. (2018). Conflicts of conscience in the neonatal intensive care unit: Perspectives of Alberta. Nursing Ethics, 25(8), 992–1003.
Gaíva M. A. M. & Scochi C. G. S. (2005). A participação da família no cuidado ao prematuro em UTI neonatal. Rev Bras Enferm. 2005; 58(4):444-8.
Gallagher K., Partridge C., Tran H.T., Lubran S. & Macrae D. (2017). Nursing& parental perceptions of neonatal care in central vietnam: a longitudinal qualitative study. BMC
Pediatrics, 17(1), 161.
Gonya J., Harrison T., Feldman K., Stein M. & Chawla N. (2018). Nursing networks in the NICU and their association with maternal stress: a pilot study. Journal of Nursing
Management, 27(2).
Green A. (2006). Nursing and midwifery: Millennium development goals and the global human resource crisis. Int Nurs Rev. 53:13–5.
Green J., Darbyshire P., Adams A. & Jackson D. (2015). Balancing hope with reality: how neonatal nurses management the uncertainty of caring for extremely premature babies.
Journal of Clinical Nursing, 24(17-18), 2410-2418.
Green J., Darbyshire P., Adams A. & Jackson D. (2015). Looking like a proper baby: nurses’ experiences of caring for extremely premature infants. Journal of Clinical Nursing, 24(1-2), 81-89.
Hale R. & Levy L. (1982). Staff nurses coping in an NICU. In Coping with Caring for Sick
Newborns. 103–130.
Hall E. O. C., Kronborg H., Aagaard H. & Ammentorp J. (2010). Walking the line between the possible and the ideal: lived experiences of neonatal nurses. Intensive & critical care
nursing, 26(6), 307-313.
Heinemann A. B., Hellstrom-Westas L. & Hedberg N. K. (2013). Factors affecting parents’ presence with their extremely preterm infants in a neonatal intensive care room. Acta
29
Hendricks-Muñoz K. D. & Prendergast C. C. (2007). Barriers to provision of developmental care in the neonatal intensive care unit: neonatal nursing perceptions. Am J
Perinatol. 24(2): 71-7.
Jansen L. A. (2011). Two concepts of therapeutic optimism. Journal of Medical Ethics 37, 563–566.
Jones L., Woodhouse D. & Rowe J. (2007). Effective nurse parent communication: a study of parents’ perceptions in the NICU environment. Patient Education and Counselling, 69, 206–212.
Koh T. H. H. G., Butow P. N., Coory M., Budge D., Collie L. A. & Whitehall J. (2007). Provision of taped conversations with neonatologists to mothers of babies in intensive care: randomised controlled trial. British Medical Journal, 337, 28.
Kozier B., Erb G., Berman A., Snyder S., Harvey S. & Morgan-Samuel H. (2012). Fundamentals of Nursing, concepts, process and practice (2nd ed.). Harlow: Person
Education Limited, 12(2): 0-0.
Lupton D. & Fenwick J. (2001). They’ve forgotten that I’m the mum’: constructing and practising motherhood in special care nurseries. Soc Sci Med; 53:1011–21.
Martinez A. M., Khu D. T. K., Boo N. Y., Neou L. & Partridge J. C. (2012). Barriers to neonatal care in developing countries: parents' and providers' perceptions. Journal of
Paediatrics & Child Health, 48(9), 852-858.
McHaffie H. E. & Fowlie P. W. (1996). Life, Death and Decisions: Doctors and Nurses
Reflect on Neonatal Practice. Journal of Medical Ethics, 24(2), 135-136.
Melnyk B. M., Alpert-Gillis L., Feinstein N. F., Fairbanks E. & Sinkin R. A. (2001). Improving cognitive development of low-birth-weight premature infants with the cope program: a pilot study of the benefit of early NICU intervention with mothers. Research in
Nursing & Health, 24(5), 373-389.
30
intensive care unit program: a randomized, controlled trial. Pediatrics, 118(5), e1414-e1427.
Merighi M. A. B., Jesus M. C. P. D., Santin K. R. & Oliveira D. (2011). Caring for newborns in the presence of their parents: the experience of nurses in the neonatal intensive care unit. Revista Latino Americana De Enfermagem, 19(6), 1398-1404.
Morelius E. & Anderson G. C. (2015). Neonatal nurses’ beliefs about almost continuous parent-infant skin-to-skin contact in neonatal intensive care[J]. Journal of Clinical Nursing, 24(17-18): 2620-2627.
National Health and Family Planning Commission of PRC. (2018). Bureau of Statistics: China's population will increase by 5.3 million in 2018. Retrieved January 21, 2019 from
http://baijiahao.baidu.com/s?id=1623234255259789376&wfr=spider&for=pc
Neonatal nursing scope and standards of practice. (2013). Correctional Nursing: Scope
and Standards of Practice. National Association of Neonatal Nurses.
Pannacciulli C. (2012). Counselling skills to improve the nursing relational system within the NICU. Early Human Development, 88, S16–S18.
Polit D. F. & Beck C. T. (2017). Nursing Research: Generation and Assessing Evidence
for Nursing Practice. (Tenth edition) Philadelphia, America: Wolters Kluwer.
Roy C. (1970). Adaptation: A conceptual framework for nursing. Nursing Outlook, 18, 42-45.
Shrestha, S., Petrini, M. & Turale, S. (2013). Newborn care in Nepal: the effects of an educational intervention on nurses’ knowledge and practice. International Nursing Review, 60(2), 205–211.
Strandås, M. & Fredriksen S. T. (2015). Ethical challenges in neonatal intensive care nursing. Nursing Ethics, 22(8), 901.
31
Trajkovski S., Schmied V., Vickers M. & Jackson D. (2012). Neonatal nurses’ perspectives of family‐centred care: a qualitative study. Journal of Clinical Nursing, 21(17‐18), 2477-2487.
Turner D. S. & Stokes L. (2006). Hope promoting strategies of Registered Nurses. Journal
of Advanced Nursing 56, 363–372.
Turner M., Chur-Hansen A. & Winefield H. (2014). The neonatal nurses' view of their role in emotional support of parents and its complexities. Journal of Clinical Nursing, 23,3156– 3165
Van Riper M. (2001). Family–provider relationships and well-being in families with preterm infants in the NICU. Heart Lung; 30:74-84.
Vaismoradi M., Salsali M. & Ahmadi F. (2011). Nurses’ experiences of uncertainty in clinical practice: a descriptive study. Journal of Advanced Nursing 67, 991–999.
Vasconcelos M. G. L., Leite A. M. & Scochi C. G. S. (2006). Significados atribuídos à vivência materna como acompanhante do recém-nascido pré-termo e de baixo peso. Rev
Bras Saúde Mater Infant. 6(1): 47-57
White R. D., Smith J. A. & Shepley M. M. (2013). Committee to Establish Recommended Standards for Newborn ICUD. Recommended standards for newborn ICU design, eighth edition. J Perinatol. 33(Suppl): S2–S16.
Wigert H., Johansson R., Berg M. & Anna L. (2006). Mothers' experiences of having their newborn child in a neonatal intensive care unit. scandinavian journal of caring sciences, 20(1), 35-41.
Wigert H., Hellstrom A. L. & Berg M. (2008). Conditions for parents’ participation in the care of their child in neonatal intensive care--a field study. BMC Pediatr. 8:3.
Yang T.T. (2017). Clinical Nursing Analysis of Neonatal Intensive Care Unit. Journal of
32 APPENDIX 1
Themes Sub-themes Study findings
Nurses’ experiences of the emotions during the nursing process
Negative emotions
E1. Anxiety E3. Disappointing B1. Grief A6. Feel guilt
B2. Imagined themselves in the same situation F1. Feeling shocked
C1. Feeling powerless,hopeless and guilty C5. Feeling sad and uneasy
Positive emotions
J1. Enjoyable and rewarding D2. Stastify
D1. Sense of pride G5. Joy
Nurses’ experiences of difficulties during the nursing process Difficulties in caring for parents
J7. Lack of parent engagement
J8. Have language and cultural barriers with parents
G2. The nurse can interpret the body language between the parents and the child.
33
Difficulties for nurse and care requirement
J5. Lack of time .(G3)
J6. Limitation with physical space B4. Lack of necessary skills
E2. Can’t certain the patients prognosis C4. Nurses are more vulnerable
H6. Patient situations have impact on nurses
Difficulties in caring for infant
D7. Incapable of infants suffering from illness D8. Inform parents that their babies died F2. Baby’s vulnerable and fragile
F3. The practical care difficulties and challenges
Difficulties in nursing environment
J4. Need positive environment . G4. The environment was important. A5. Need quiet environment G5. Teamwork was very helpful B3. Providing humane care
What to do
For parents
J2. Give individualized support for each parent
J3. Encouraged and guidance for parents in caring for their baby (h2, i3) A2. Promoting and respecting parent’s role
34
G1. Attentive to the infant and the mother—infant dyad A1. Facilitate parent-infant closeness(h5)
I2. Develop and build trusting
Adaption and coping For nurses
F4. Do not face emotions directly
D4. More intimate and interactive after training
D5. The knowledge of nurses make them more confident C2. Experience and time acted as a source of guidance C3. Follow nurse conscience
H5. Developed good coping strategies
35 APPENDIX 2
Authors Title Design and approach Sample Data collection method Method of data analysis Feeley N. Genest C. Niela-Vilén H. Charbonne L. Axelin A. Year of publication: 2016 Country: Canada
Parents and nurses balancing parent-infant closeness and separation: a qualitative study of NICU nurses’perceptions
A descriptive design with a qualitative approach
Number:37
Age: in Canada were 28.4 years on average, in Finland were38.7 (SD = 11.4) years old Gender:
All female
Worked years in NICU: majority more than one year
Individual semi-structured in-depth interviews with open-ended quiestions.
Length of interview:
60 to 90 minutes. The interviews were recorded and transcribed. thematic analysis (Vaismoradi M, Turunen H, Bondas T.,2013) Fernanda D.C. D. O. Cleveland L.M.
Darilek U. Borges Silva A.R. & Carmona, E.V. 2018+Brazil
Year of publication: 2018 Country: Brazil
Brazilian Neonatal Nurses’ Palliative Care Experiences
A descriptive study with a qualitative approach
Number:9
Age:34 to 57 years old
Gender:
Two were male and 7 were female
Worked years on average:
No information
Worked years in NICU:
18 months to 20 years
Semi-structured inter views
Length of interview:
60 to 90 minutes interview was audio-recorded Thematic analysis (Boyatzis’ 1998) Ford N.J. Austin W. Year of publication: 2017 Country: Vietnam Conflicts of conscience in the neonatal intensive care unit: Perspectives of Alberta
A descriptive design with a qualitative approach
Number:5. Age:27~53. Gender: female.
average years of work on neonatal intensive care unit:2.5–32 years of neonatal nursing
experience and 7–32 years
Length of interview: 30– 60 min
semi-structured interview interviews were
audio-recorded and transcribed verbatim.
36 of registered nurse experience. Gallagher K. Partridge C. Hoang T. Macrae D. lubran S. Year of publication: 2017 Country: Vietnam
Nursing & parental perceptions of neonatal care in Central Vietnam: a longitudinal qualitative study
A study with a qualitative approach.
Number:26 average years of work on neonatal intensive care unit:2 to 30 years
Length of interview: 20 min
Semi-structured interview
manifest content (Kondraki NL 2002) Green J. Darbyshire D. Adams A. Jackson D. Year of publication: 2014 Country:sydney
Looking like a proper baby: nurses’ experiences of caring for extremely premature infants
Qualitative approach Number ： 24 average years of work on
neonatal intensive care unit :5 years
had undergone treatment for PPD.
semi-structured interviews Length of interview: 60-120 mins. The interviews were recorded and transcribed.
Content analysis (Elo et al., 2014). Green J. Darbyshire P. Adams A. Jackson D. Year of publication: 2015 Country: Australia
Balancing hope with reality: how neonatal nurses management the uncertainty of caring for extremely premature babies
Qualitative approach Number:12
Age:34 to 52 years old Gender:no information Worked years in NICU: 10–28 years
Worked years with caring for extremely premature babies:at least eight years
semi-structured interviews interviews
Length of interview: 60–90 minutes Recorded using audio tape
phenomenological approach
37 Hall E.O.C. Kronborg H. Aagaard H. Ammentorp J. Year of publication: 2010 Country: Denmark
Walking the line between the possible and the ideal: Lived experiences of neonatal nurses
A descriptive study with qualitative approach. Number:7 Age:from 27 to 52 (median 38) years old, Gender:all women Worked years on average:1 to 25 (median 12) years.
Worked years in NICU: No information
interview
Length of interview: 60 minutes
Recorded with tape-recorded Phenomenologic - hermeneutic approach (Van Manen, 1990) Stranda M. Sven-Tore D. Year of publication: 2015 Country: Norway Ethical challenges in neonatal intensive care nursing
Qualitative approach. Number:6. Age:42～54. Gender:female.
average years of work on neonatal intensive care unit：6 to 23 years. Length of interview:lasting 35–60 min. semi-structured interview taped transcribed verbatim.
Phenomenological-hermeneutic analysis (kvale &Brinkmann 2009) Trajkovski S, Schmied V, Vickers M Jackson D. Year of publication: 2012 Country:Australia Neonatal nurses’ perspectives of family-centred care: a qualitative study A descriptive design A qualitative approach Number:33 Age:25~64years Gender:women
average years of work on neonatal intensive care unit :ranged from first year postgraduate nurses to senior experienced nurses with more than 15 years of service in this particular neonatal unit
Length of interview:lasting 35–60 min. semi-structured interview taped transcribed verbatim.
Narrative analysis and constant comparison approach.
Turner M. Chur-Hansen A.
The neonatal nurses’ view of their role in emotional support of
A descriptive exploratory design
Number:9
Age:between 32–58 years
38 Winefifield H.
Year of publication: 2014 Country:Australia
parents and its complexities
A qualitative approach
Gender:all women Worked years on average:No information Worked years in NICU: No information
45–70 minutes Interviewed were transcribed verbatim
39 APPENDIX 3
Author(s) +year/country of publication
Aim Results Codes
Feeley N. Genest C. Niela-Vilén H. Charbonne L Axelin A. 2016+Canada
explore from nurses’ perspective, what do parents and nurses do to promote parent-infant closeness or provoke separation.
A1. Facilitate parent-infant closeness
A2. Promoting and respecting parent’s role
A3. Encouraged parents have physical contact with their infant
A4. Providing emotional support
A5. Need quiet environment
A6. Feel guilt
A Fernanda D.C.D.O. Cleveland L.M. Darilek U. Borges Silva A.R. & Carmona, E.V.
explore the palliative care （PC） experiences of Brazilian NICU nurses.
B1. Grief
B2. Imagined themselves in the same situation B3. Providing humane care
40
2018+Brazil
Ford N.J. Austin W. 2017+Vietnam
To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta.
C1.Feeling powerless，hopeless，and guilty C2. Experience and time acted as a source of guidance C3. Follow nurse conscience
C4. Nurses are more vulnerable C5. Feeling sad and uneasy
C Gallagher K. Partridge C. Hoang T. Macrae D. lubran S. 2017+Vietnam.
The aim of this study was to explore changes in the perceptions and attitudes of nurses and parents towards their experiences in the neonatal unit following a neonatal nursing education intervention in a single neonatal unit in central Vietnam.
D1. More intimate and interactive after training D2. The knowledge of nurses let them more confident D3. Instruct parents how to support us
D4. Sympathize with the patient parents D5. Encourage parents
D6. Upset and awkward when nurse could not save babies’ lives D7. Inform parents that their babies died is the biggest challenge
D
Green J. Darbyshire P. Adams A. Jackson D.
Explore the ways in which neonatal
nurses manage the uncertainty associated with the treatment and outcomes of
E1. Anxious
E2. Infant prognosis was unpredictable
41
2015+Australia
extremely premature babies.
Green J. Darbyshire D. Adams A. Jackson D. 2014+Sydney
To explore the ways in which neonatal nurses draw meaning and deal with the challenges associated with caring for extremely premature babies.
F1. Feel shocked
F2. Vulnerable and fragile
F3. The practical care difficulties and challenges F4. Don't face emotions directly
F Hall E.O.C. Kronborg H. Aagaard H. Ammentorp J. 2010+ Denmark
To investigate the lived experiences of neonatal nurses.
G1. Attention to the infant and the mother—infant dyad.
G2. The nurse can interpret the body language between the parents and the child G3. Lack of time.
G4. The environment was important. G5. Teamwork was very helpful G6. Joy G7. Grief G Stranda M. Sven-Tore D. 2015+Norway
The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns.
H1.Interact with parents is as rewarding as well as challenging. H2. Understand the parents’ situation
H3. Communicating clearly and honestly H4. Evaluate the parents’ emotional condition H5. Developed good coping strategies H6. Patient situations have impact on nurses. H7. Requires particular sensitivity and attentiveness
42 Trajkovski S, Schmied V, Vickers M and Jackson D. 2012+ Australia
The aim of this study is to explore neonatal nurses’ perspectives of their role in facilitating family centred care in the neonatal intensive care unit.
I1. Deliver care that is individual I2. Develop and build trusting
I3. Provide encouragement and support I4. Not adequately trained
I5. Share information and guide families
I6. More experienced and confident are better to talk
I Turner M. Chur-Hansen A. Winefifield H. 2014+Australia
To explore the nurses’ views of their role both in the neonatal intensive care unit and in the provision of interacting with, and emotionally supporting of the families.
J1. Enjoyable and rewarding J2. Challenging
J3.Give individual support for each parent
J4. Encouraged and guidance for parents in caring for their baby
J5. Need positive environment. J6. Lack of time.
J7. Limitation with physical space. J8. Lack of parent engagement
J9. Have language and cultural barriers with parents
J10. Requiring training, experience and seniority.
